Anti-Microbial Resistance Diagnostics Paper
Read Full Report – AMR Diagnostic technologies_10 June 2015
How to cite the report – Annette Pluddemann, Igho Onakpoya, Sian Harrison, Bethany Shinkins, Bethany Shinkins, Alice Tompson, Ruth Davis, Christopher P. Price and Carl Heneghan. Position Paper on Anti-Microbial Resistance Diagnostics – Centre for Evidence-Based Medicine, University of Oxford June 2015. https://www.cebm.net/wp-content/uploads/2015/07/AMR-Diagnostic-technologies_10-June-2015.pdf DOI:10.13140/RG.2.1.1135.9846.
There is no doubt that tackling antibiotic resistance is of major public health importance to global health systems. This report highlights the considerable number of new diagnostic technologies in development to underpin the rational prescribing of antibiotics.
What this report also shows is that innovative diagnostics will only provide part of the solution. It is therefore essential that ongoing strategies address barriers to change , as they are identified and when they arise, along with co-ordinated educational and informatics strategies that target unwarranted variations in practice and promote and evidence-based culture of change.
Approaches to antimicrobial resistance must continue to focus on both appropriateness as well as strategies to reduce antibiotic use. Importantly, interventions need to be sustained over the long term: the time taken to observe reductions in the incidence of antibiotic-resistant organisms is considerably longer than the time to reach high levels of resistance in the first place.
It has been consistently shown that in addressing changes in practice no single quality improvement strategy is more effective than another. Therefore a co-ordinated approach is essential: combining physician, patient and public education along with Informatics systems that are fit for purpose and highlight disparities in practice.
Based on current evidence single test assays will likely prove to be ineffective, therefore research and development should focus on multiplex systems reflecting clinical presentations that are often affected by multiple organisms. Part of the solution, though, lies with restructuring the development of the evidence base for many tests: the current system is burdensome and inefficient leading to a dearth of clinical trial data to aid application and uptake into clinical care.
What might a coordinated approach and therefore success look like? Rapid reporting of laboratory results, same-day results, infrastructure for research ready point-of-care testing sites, informatics systems and automatic alerts that promote appropriate prescribing, information systems that share best practice; along with a culture that develops and implements interventions aimed at specific healthcare settings, which constantly addresses barriers to change, will all have significant benefits for antibiotic stewardship in the future.
Professor of Evidence-Based Medicine
Director of the Centre for Evidence-Based MedicineUniversity of Oxford
Presentation by Carl Heneghan at the Department of Health Workshop – Diagnostics and their use in addressing Antimicrobial ResistanceDiagnostics and their use in addressing Antimicrobial Resistance Churchill War Rooms, Clive Steps, King Charles Street, London, SW1A 2AQ. 15/07/2015